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Background Improvements to the primary prevention of physical health illnesses like diabetes in the general population have not been mirrored to the same extent in people with serious mental illness (SMI). This work evaluates the technical feasibility of implementing an electronic clinical decision support system (eCDSS) for supporting the management of dysglycaemia and diabetes in patients with serious mental illness in a secondary mental healthcare setting. Methods A stepwise approach was taken as an overarching and guiding framework for this work. Participatory methods were employed to design and deploy a monitoring and alerting eCDSS. The eCDSS was evaluated for its technical feasibility. The initial part of the feasibility evaluation was conducted in an outpatient community mental health team. Thereafter, the evaluation of the eCDSS progressed to a more in-depth in silico validation. Results A digital health intervention that enables monitoring and alerting of at-risk patients based on an approved diabetes management guideline was developed. The eCDSS generated alerts according to expected standards and in line with clinical guideline recommendations. Conclusions It is feasible to design and deploy a functional monitoring and alerting eCDSS in secondary mental healthcare. Further work is required in order to fully evaluate the integration of the eCDSS into routine clinical workflows. By describing and sharing the steps that were and will be taken from concept to clinical testing, useful insights could be provided to teams that are interested in building similar digital health interventions.

Information extraction systems and techniques have been largely used to deal with the increasing amount of unstructured data available nowadays. Time is among the different kinds of information that may be extracted from such unstructured data sources, including text documents. However, the inability to correctly identify and extract temporal information from text makes it difficult to understand how the extracted events are organised in a chronological order. Furthermore, in many situations, the meaning of temporal expressions (timexes) is imprecise, such as in “less than 2 years” and “several weeks”, and cannot be accurately normalised, leading to interpretation errors. Although there are some approaches that enable representing imprecise timexes, they are not designed to be applied to specific scenarios and difficult to generalise. This paper presents a novel methodology to analyse and normalise imprecise temporal expressions by representing temporal imprecision in the form of membership functions, based on human interpretation of time in two different languages (Portuguese and English). Each resulting model is a generalisation of probability distributions in the form of trapezoidal and hexagonal fuzzy membership functions. We use an adapted F1-score to guide the choice of the best models for each kind of imprecise timex and a weighted F1-score ( $$\hbox {\textit{F}1}_{3\mathrm{D}}$$ ) as a complementary metric in order to identify relevant differences when comparing two normalisation models. We apply the proposed methodology for three distinct classes of imprecise timexes, and the resulting models give distinct insights in the way each kind of temporal expression is interpreted.

Funder: EPSRC Healtex Feasibility Funding (grant EP/N027280/1): "Towards Shareable Data in Clinical Natural Language Processing: Generating Synthetic Electronic Health Records", Funder: National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, Funder: National Institute for Health Research Post Doctoral Fellowship award (grant number PDF-2017-10-029), Funder: Health Data Research UK, Funder: Swedish Research Council(2015-00359)/the Marie Sklodowska Curie Actions, A serious obstacle to the development of Natural Language Processing (NLP) methods in the clinical domain is the accessibility of textual data. The mental health domain is particularly challenging, partly because clinical documentation relies heavily on free text that is difficult to de-identify completely. This problem could be tackled by using artificial medical data. In this work, we present an approach to generate artificial clinical documents. We apply this approach to discharge summaries from a large mental healthcare provider and discharge summaries from an intensive care unit. We perform an extensive intrinsic evaluation where we (1) apply several measures of text preservation; (2) measure how much the model memorises training data; and (3) estimate clinical validity of the generated text based on a human evaluation task. Furthermore, we perform an extrinsic evaluation by studying the impact of using artificial text in a downstream NLP text classification task. We found that using this artificial data as training data can lead to classification results that are comparable to the original results. Additionally, using only a small amount of information from the original data to condition the generation of the artificial data is successful, which holds promise for reducing the risk of these artificial data retaining rare information from the original data. This is an important finding for our long-term goal of being able to generate artificial clinical data that can be released to the wider research community and accelerate advances in developing computational methods that use healthcare data.